Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Ear barotrauma

David M Vernick, MD
Section Editor
Daniel G Deschler, MD, FACS
Deputy Editor
Daniel J Sullivan, MD, MPH


The middle ear is a gas-filled space. It is separated from the outside world by the tympanic membrane laterally and the eustachian tube anteromedially. Pressure within the middle ear has to match that of the outside world for the tympanic membrane to vibrate normally and for hearing to sound clear. During normal physiologic function, air in the middle ear is absorbed slowly by the lining mucous membranes and has to be continually replaced [1]. This happens normally when one swallows or yawns, opening the eustachian tube for a second and allowing air flow to occur. When the eustachian tube does not function adequately, pressure differences develop between the middle ear and the outside world. These pressure differences can distort the tympanic membrane and lead to discomfort, hearing loss, and injury, otherwise known as barotrauma.

This topic will focus on the clinical manifestations, diagnosis, and treatment of barotrauma. Other issues related to eustachian tube dysfunction are discussed in detail elsewhere. (See "Eustachian tube dysfunction".)


The eustachian tube extends from the middle ear to the nasopharynx and is made up of two parts [2]:

The posterior half leading from the ear is a bony tube lined with mucosa that does not change shape.

The anterior half is made of soft tissue that is mucosa-lined; it is normally collapsed.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 18, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Sadé J, Ar A. Middle ear and auditory tube: middle ear clearance, gas exchange, and pressure regulation. Otolaryngol Head Neck Surg 1997; 116:499.
  2. Argyros GJ. Management of primary blast injury. Toxicology 1997; 121:105.
  3. Brown TP. Middle ear symptoms while flying. Ways to prevent a severe outcome. Postgrad Med 1994; 96:135.
  4. Rosenkvist L, Klokker M, Katholm M. Upper respiratory infections and barotraumas in commercial pilots: a retrospective survey. Aviat Space Environ Med 2008; 79:960.
  5. Clenney TL, Lassen LF. Recreational scuba diving injuries. Am Fam Physician 1996; 53:1761.
  6. Moon RE. Treatment of diving emergencies. Crit Care Clin 1999; 15:429.
  7. Parell GJ, Becker GD. Conservative management of inner ear barotrauma resulting from scuba diving. Otolaryngol Head Neck Surg 1985; 93:393.
  8. Parell GJ, Becker GD. Inner ear barotrauma in scuba divers. A long-term follow-up after continued diving. Arch Otolaryngol Head Neck Surg 1993; 119:455.
  9. Uzun C, Adali MK, Tas A, et al. Use of the nine-step inflation/deflation test as a predictor of middle ear barotrauma in sports scuba divers. Br J Audiol 2000; 34:153.
  10. Klingmann C, Praetorius M, Baumann I, Plinkert PK. Barotrauma and decompression illness of the inner ear: 46 cases during treatment and follow-up. Otol Neurotol 2007; 28:447.
  11. Brocks C, Wollenberg B, Graefe H. [Acute hearing loss from scuba-diving holidays: diagnosis and treatment of barotrauma of the inner ear]. HNO 2009; 57:262.
  12. Hizel SB, Muluk NB, Budak B, Budak G. Does scuba diving cause hearing loss? J Otolaryngol 2007; 36:247.
  13. Goplen FK, Aasen T, Grønning M, et al. Hearing loss in divers: a 6-year prospective study. Eur Arch Otorhinolaryngol 2011; 268:979.
  14. Fitzpatrick DT, Franck BA, Mason KT, Shannon SG. Risk factors for symptomatic otic and sinus barotrauma in a multiplace hyperbaric chamber. Undersea Hyperb Med 1999; 26:243.
  15. Leach RM, Rees PJ, Wilmshurst P. Hyperbaric oxygen therapy. BMJ 1998; 317:1140.
  16. Bessereau J, Tabah A, Genotelle N, et al. Middle-ear barotrauma after hyperbaric oxygen therapy. Undersea Hyperb Med 2010; 37:203.
  17. Klingmann C. Inner ear decompression sickness in compressed-air diving. Undersea Hyperb Med 2012; 39:589.
  18. Tungsinmunkong S, Chongkolwatana C, Piyawongvisal W, et al. Blast injury of the ears: the experience from Yala Hospital, Southern Thailand. J Med Assoc Thai 2007; 90:2662.
  19. Ritenour AE, Wickley A, Ritenour JS, et al. Tympanic membrane perforation and hearing loss from blast overpressure in Operation Enduring Freedom and Operation Iraqi Freedom wounded. J Trauma 2008; 64:S174.
  20. Perez R, Gatt N, Cohen D. Audiometric configurations following exposure to explosions. Arch Otolaryngol Head Neck Surg 2000; 126:1249.
  21. Breeze J, Cooper H, Pearson CR, et al. Ear injuries sustained by British service personnel subjected to blast trauma. J Laryngol Otol 2011; 125:13.
  22. Akin FW, Murnane OD. Head injury and blast exposure: vestibular consequences. Otolaryngol Clin North Am 2011; 44:323.
  23. Gutovitz S, Weber K, Kaciuban S, et al. Middle ear pressure and symptoms after skydiving. Aviat Space Environ Med 2008; 79:533.
  24. Sato S, Yokoi H, Fukuta S, et al. Morphological studies on middle ear barotrauma in guinea pigs. Nagoya J Med Sci 1997; 60:109.
  25. Strohm M. Trauma of the middle ear. Clinical findings, postmortem observations and results of experimental studies. Adv Otorhinolaryngol 1986; 35:1.
  26. Jones JS, Sheffield W, White LJ, Bloom MA. A double-blind comparison between oral pseudoephedrine and topical oxymetazoline in the prevention of barotrauma during air travel. Am J Emerg Med 1998; 16:262.
  27. Csortan E, Jones J, Haan M, Brown M. Efficacy of pseudoephedrine for the prevention of barotrauma during air travel. Ann Emerg Med 1994; 23:1324.
  28. Mirza S, Richardson H. Otic barotrauma from air travel. J Laryngol Otol 2005; 119:366.
  29. Duplessis C, Fothergill D, Gertner J, et al. A pilot study evaluating surfactant on eustachian tube function in divers. Mil Med 2008; 173:1225.
  30. Foster PP, Butler BD. Decompression to altitude: assumptions, experimental evidence, and future directions. J Appl Physiol (1985) 2009; 106:678.
  31. Klokker M, Vesterhauge S, Jansen EC. Pressure-equalizing earplugs do not prevent barotrauma on descent from 8000 ft cabin altitude. Aviat Space Environ Med 2005; 76:1079.
  32. Fernau JL, Hirsch BE, Derkay C, et al. Hyperbaric oxygen therapy: effect on middle ear and eustachian tube function. Laryngoscope 1992; 102:48.
  33. Poe DS, Silvola J, Pyykkö I. Balloon dilation of the cartilaginous eustachian tube. Otolaryngol Head Neck Surg 2011; 144:563.
  34. Catalano PJ, Jonnalagadda S, Yu VM. Balloon catheter dilatation of Eustachian tube: a preliminary study. Otol Neurotol 2012; 33:1549.
  35. Williams B, Taylor BA, Clifton N, Bance M. Balloon dilation of the Eustachian tube: a tympanometric outcomes analysis. J Otolaryngol Head Neck Surg 2016; 45:13.
  36. Goplen FK, Grønning M, Aasen T, Nordahl SH. Vestibular effects of diving - a 6-year prospective study. Occup Med (Lond) 2010; 60:43.